NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera Medical Group Eye Care

  • Ophthalmology Physician
  • Sioux Falls, SD
National Provider Identifier
1417246901
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
AVERA MCKENNAN
Doing business as
Avera Medical Group Eye Care
Avera Medical Group Ophthalmology Sioux Falls
Practice address
911 E 20TH St Ste 101
Sioux Falls, SD 57105-1043
Phone
(605) 322-3790
Fax
(605) 322-3791
NPI assigned
Apr 5, 2011
Last updated
Nov 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Flicek
Title
Senior VP of Finance
Phone
(605) 322-7915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

911 E 20TH St Ste 101
Sioux Falls, SD 57105-1043

Mailing address

PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-7510

Other names 2

  • Avera Medical Group Eye Care Doing business as
  • Avera Medical Group Ophthalmology Sioux Falls Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MN, IA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20031110000117 SD Part B Supplier - Clinic/Group Practice 0345157103 Receives reassigned benefits from 1,418 practitioners
This NPI is an additional NPI on the enrollment
O20040109001102 MN Part B Supplier - Clinic/Group Practice 0345157103 Receives reassigned benefits from 81 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Worthington, MN; Windom, MN; Tyler, MN; Slayton, MN; Pipestone, MN; Lakefield, MN; Ortonville, MN; Marshall, MN…
O20040206000384 IA Part B Supplier - Clinic/Group Practice 0345157103 Receives reassigned benefits from 91 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rock Valley, IA; Spirit Lake, IA; Spencer, IA; Sioux Center, IA; Sibley, IA; Rock Rapids, IA; Milford, IA; Mason City, IA…
O20040506000713 SD Part A Provider - Hospital 0345157103 22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417246901. Details of each certification follow.

Hospital certification: CCN 430016

Legal name
AVERA MCKENNAN
Doing business as
AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 3, 2011
Beds
505
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 23, 1925 in SD
Enrollment address
1325 S Cliff Ave
Sioux Falls, SD 57105-1007
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 47

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

  • Avera McKennan

    dba Avera Medical Group Urogynecology Sioux Falls

    • Obstetrics & Gynecology Physician
    • Sioux Falls, SD
    • NPI 1003188269

    O20040109001102, O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group Rheumatology Sioux Falls

    • Rheumatology Physician
    • Sioux Falls, SD
    • NPI 1013177393

    O20040206000384, O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group University Psychiatry Associates Sioux Falls

    • Psychiatry Physician
    • Sioux Falls, SD
    • NPI 1013980598

    O20040109001102, O20040206000384, O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group Oncology and Hematology Sioux Falls

    • Hematology & Oncology Physician
    • Sioux Falls, SD
    • NPI 1033185582

    O20040109001102, O20040206000384

    Same enrollment
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678

    O20040109001102, O20040206000384

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group Orthopedics and Sports Medicine

    • Orthopaedic Surgery Physician
    • Sioux Falls, SD
    • NPI 1093262131

    O20040109001102, O20040206000384, O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera Nephrology

    • Nephrology Physician
    • Sioux Falls, SD
    • NPI 1104892892

    O20040109001102, O20040206000384

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group Brain and Spine Institute

    • Neurological Surgery Physician
    • Sioux Falls, SD
    • NPI 1114113693

    O20040206000384, O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group Physical Medicine and Rehabilitation Sioux Falls

    • Physical Medicine & Rehabilitation Physician
    • Sioux Falls, SD
    • NPI 1134195332

    O20040109001102, O20040206000384, O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera McKennan Hospital and University Health Center - Diabetic Ed

    • General Acute Care Hospital
    • Sioux Falls, SD
    • NPI 1154531630

    O20040506000713

    Same enrollment
  • Avera McKennan

    dba Avera Medical Group McHale Institute

    • Hematology & Oncology Physician
    • Sioux Falls, SD
    • NPI 1164780201

    O20040109001102

    Same enrollment
  • Avera McKennan
    • General Acute Care Hospital
    • Sioux Falls, SD
    • NPI 1184834764

    O20040506000713

    Same enrollment
View all 47

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera McKennan Hospital & University Health CenterCCN 430016 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

6709 S Minnesota Ave
Ste 102
Sioux Falls, SD 57108
Phone (605) 322-7250

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alisa L Reindl Individual Corporate DirectorBoard Member Jul 1, 2021
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Tamera L Sturm Individual Corporate DirectorBoard Member Jul 1, 2025
Van Fishback Individual Corporate DirectorBoard Member Jul 1, 2018
Candyce C Chrystal Individual Corporate DirectorBoard Member Jul 1, 2024
Harriet Yocum Individual Corporate DirectorBoard Member Jul 1, 2021
Jennifer Bunkers Individual Corporate DirectorBoard Member Jul 1, 2021
Randy Knecht Individual Corporate DirectorBoard Member Jul 1, 2018
Jawad Nazir Individual Corporate DirectorBoard Member Jul 1, 2020
Lucille F Welbig Individual Corporate DirectorBoard Member Jul 1, 2015
Joseph Patrick Costello Individual Corporate DirectorBoard Member Jul 1, 2017
Sanaa Abourezk Individual Corporate DirectorBoard Member Jul 1, 2024
Amanda Marie Schutz Individual Contracted Managing Employee Jun 15, 2018
Ryan Boschee Individual Corporate DirectorBoard Member Jul 1, 2024
Jennifer Kirby Individual Corporate DirectorBoard Member Jul 1, 2020
Ronald J. Place Individual Corporate OfficerPresident/Ceo Jun 5, 2023
Operational/Managerial Control Jun 5, 2023
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Mary C Curran Individual Corporate DirectorBoard Member Jul 1, 2017
Avera Health Organization, Sioux Falls, SD Corporation, Chain home office 5% Or Greater Direct Ownership Interest Jul 1, 2000
Operational/Managerial Control Jul 1, 2000
Roxanne P Seifert Individual Corporate DirectorBoard Member Jul 1, 2024
Cristina a Hill Jensen Individual Corporate DirectorBoard Member Jul 1, 2018
Benjamin M Solomon Individual Corporate DirectorBoard Member Jul 1, 2022

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

Affiliated clinicians 1,295

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,295

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1417246901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86370",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571186370",
            "telephone_number": "605-322-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 E 20TH ST STE 101",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051043",
            "telephone_number": "605-322-3790",
            "fax_number": "605-322-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "FLICEK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "SENIOR VP OF FINANCE",
        "authorized_official_telephone_number": "605-322-7915"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Medical Group Ophthalmology Sioux Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.